| NPI | 1487829800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC WILLIAM WILD President 304-523-8671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WV 2466) |
| Enumeration Date | 2008-04-26 |
| Last Update Date | 2008-04-26 |